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Health & Welfare Plans Newsletter

May 9, 2023

2 New Job Opportunities 2 New Job Opportunities


[Guidance Overview]

IRS Confirms That All FSA Claims Must Be Substantiated, No Matter How Small

"According to the IRS [Chief Counsel Memorandum], it is not only these unsubstantiated expenses that are taxable. If expenses are not properly substantiated, then the employer's cafeteria plan is invalid. In other words, all deductions for medical insurance premiums, FSAs, and any other items would be treated as taxable compensation to the employees. All FSA reimbursements would be taxable as well."  MORE >>

HUB International

[Guidance Overview]

Here We Go Again: Prescription Drug Reporting Due by June First

"[C]hanges for 2022 reporting [may] require some quick pivots to ensure the plan is on track to meet its reporting obligations.... [P]lan sponsors that may have missed vendor deadlines that would permit the vendor to complete the required reporting on the plan's behalf should put together an action plan to submit the required data by June 1, 2023 -- as of now, there is no extension of this deadline and no relief that would excuse the plan's non-compliance."  MORE >>


[Guidance Overview]

Exceptional Usefulness and Quality icon End of the COVID-19 National Emergency: What It Means for ERISA-Covered Group Health Plans

"[1] Modified deadlines ... [1] Qualifying event notice ... [3] Sending COBRA election notices ... [4] COBRA election period ... [5] First COBRA payment due date ... [6] COBRA payment due date ... [7] Claim filing deadline ... [8] Internal appeal deadline ... [9] External appeal deadline ... [10] Special enrollment ... [11] Plan sponsor/administrator considerations ... [12] Document changes."  MORE >>

Phillips Lytle LLP

[Guidance Overview]

The End of the COVID-19 Emergency Declarations Raises Questions, But FAQs Provide Answers

"[It] is the DOL's position that FAQs Part 58 announced the end of the National Emergency as July 10, 2023.... [G]roup health plans and issuers (i.e., insurers) are either required or 'encouraged' to provide notice of COVID-19-related benefits coverage changes to plan participants, and in some cases beneficiaries and other enrollees ... [T]he Outbreak Period deadline extensions ... will cease to apply effective 60 days after the end of the National Emergency.... [T]he Departments note that nothing prevents a plan or issuer from permitting longer timeframes to provide notices and elections under these provisions and plans are encouraged to do so."  MORE >>

Verrill Dana LLP

[Guidance Overview]

Plan Sponsor Considerations After Federal Court Blocks Enforcement of Some ACA Preventive Health Service Requirements

"[E]mployers that sponsor health and welfare plans are still permitted to provide coverage for preventive services without participant cost sharing. The decision -- even if it stands -- only implicates the requirement (not the ability) of employer group health plans and insurers to provide this coverage.... [M]ost group health plan sponsors will be unlikely to scale back coverage for preventive services in any meaningful way."  MORE >>

Dickinson Wright

[Guidance Overview]

Colorado Public Health Emergency Ends: Sick Leave Requirements Get Simpler

"The end of the PHE ... will have effects beyond lowering paid leave requirements.... [B]ecause leave requirements are reduced, employers that could not satisfy their HFWA obligations through a general paid time off policy during the PHE may be able to now.... [E]mployers can now ask for reasonable documentation for HFWA leave requests without fear that they are violating the law."  MORE >>

Fox Rothschild LLP

Seventh Circuit Affirms Northrop Grumman Win in Class Action Dispute Over ERISA Severance Benefits

"The Seventh Circuit also reasoned that ... the Severance Plan makes the receipt of severance benefits contingent on receipt of the HR Memo. Severance benefits do not vest like retirement benefits and employers may design these plans in their own interests. The Severance Plan gives the HR department discretion to decide who gets the HR Memo." [Carlson v. Northrop Grumman Severance Plan & Northrop Grumman Corp., No. 22-1764 (7th Cir. May 8, 2023)]  MORE >>

Roberts Disability Law

What to Evaluate When Considering Narrow Networks

"Narrow networks are designed to provide cost effective access to providers with proven clinical outcomes. But not all healthcare facilities provide the level of quality necessary to make a narrow network viable for your employees. ... [1] Demographic fit  ... [2] Geographic fit ... [3] Financial fit ... [4] Cultural fit."  MORE >>

Corporate Synergies

Prices for COVID-19 Testing

"Though the vast majority of people with private health coverage will continue to have coverage for COVID-19 tests ordered or administered by a clinician, those tests may soon be subject to cost sharing, quantity limits, and prior authorization requirements.... [T]he median price of a COVID-19 test in an outpatient clinical setting was $45 in 2021 among people with large employer-based health coverage ... [T]he median discounted hospital-based self-pay rate was $51 for a COVID-19 antigen test and $91 for a PCR test.... [R]ecent prices for at-home rapid COVID-19 tests average about $11 per test."  MORE >>

The Peterson-Kaiser Health System Tracker

Understanding Coverage Considerations for COVID-19 Vaccines and Treatments

"[T]his report: [1] provides an overview of the current coverage and payment of COVID-19 vaccines and treatments across payers; [2] identifies expected gaps in coverage after the end of U.S. Government-provided supply and key considerations for coverage determinations post-PHE; and [3] presents estimates on expected savings and spending offsets for a select set of COVID-19 products that have been demonstrated to reduce COVID-19-related hospitalizations." [Updated May 2023]  MORE >>

Assistant Secretary for Planning and Evaluation [ASPE], U.S. Department of Health and Human Services [HHS]


Health Care Megatrends: System and Payment Reform

"The past decade has seen a lot of talk about value-based payments, accountable care organizations (ACOs), bundles, capitation, and the like. However, compared to the rhetoric, implementation has been plodding. But the fusing of payers and providers across the US health care system finally seems to be at a critical inflection point and will drive expansion of [alternative payment methods]."  MORE >>

Ezekiel J. Emanuel, via Health Affairs Forefront

Employee Benefits Jobs

View job as Regional Sales Director - Midwest
            for July Business Services

Regional Sales Director - Midwest

July Business Services

IL / IN / MN / MO / OH / WI

View job as Regional Sales Director - Midwest for July Business Services

View job as Retirement Plan Consultant
            for Definiti

Retirement Plan Consultant



View job as Retirement Plan Consultant for Definiti

Press Releases

October Three Consulting Acquires Retirement Learning Center

October Three, LLC

HSA Bank Expands Offerings to Help Benefit Participants Cover Education Costs

HSA Bank

MultiPlan Acquires Leading Healthcare Data and Analytics Firm Benefits Science LLC


Heffernan Insurance Brokers Entity Acquires Stitz & Associates

Heffernan Insurance Brokers

Webcasts and Conferences
(Health & Welfare Plans)

ERISA 2023: The Evolving World

July 31, 2023 WEBINAR

PLI [Practising Law Institute]

Last Issue's Most Popular Items

COBRA for the Health FSA


IRS 2022-2023 Priority Guidance Plan: Third Quarter Update (PDF)

Internal Revenue Service [IRS]

Senate Hearing on Mental Health Network Adequacy: Could Employer Plans Be Next?

HR Policy Association [HRPA]

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BenefitsLink® Retirement Plans Newsletter, ISSN no. 1536-9587.

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